A comparison of short term complication rate between 44 two- and 385 one-stage septic exchange arthroplasties in chronic periprosthetic joint infections - 12/08/20

Doi : 10.1016/j.otsr.2020.05.008

Darius M. Thiesen ^a,^b,⁎, ^{^{1
Darius M. Thiesen and Human Sobhani contributed equally to this work and therefore share first authorship.}} , Human Sobhani ^a,^{^{1
Darius M. Thiesen and Human Sobhani contributed equally to this work and therefore share first authorship.}}, Thorsten Gehrke ^a, Eduardo M. Suero ^c, Till O. Klatte ^b, Mustafa Citak ^a
^a Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Holstenstr 2, 22767 Hamburg, Germany
^b Department of Trauma- and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
^c Department of General, Trauma and Reconstructive Surgery, Ludwig Maximilian University of Marchioninistr 15, 81377 Munich, Germany

^⁎Corresponding author at: Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Holstenstr 2, 22767 Hamburg, Germany.Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, HamburgHolstenstr 2Hamburg22767Germany

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Abstract

Background

Periprosthetic joint infection is a serious disease with severe consequences for the patient's life. It is not known whether one-stage or two-stage replacement arthroplasty is superior. So far, there have been no studies on short-term complications between both surgical procedures. Therefore, we performed a retrospective study aiming to determine: 1) Does two-stage septic exchange arthroplasty have a higher short-term complication rate than one-stage? 2) Is there a difference in length of hospital stay and the in-hospital mortality rate between two- and one-stage septic exchange arthroplasty?

Hypothesis

Two-stage septic exchange arthroplasty has a higher short-term complication rate than one-stage.

Patients and methods

Retrospectively 429 patients who underwent a one- or two stage revision arthroplasty (288 hips and 141 knees) due to chronic PJI between January 2015 and December 2016 were recruited (one-stage: n=385, two-stage: n=44). Differences in postoperative complications, surgical therapy, ASA, Charlson Comorbidity Index (CCI), length of hospital, need for plastic surgery, pathogen, in-hospital morbidity and in-hospital mortality were compared using multiple logistic and Poisson regression. Regarding comorbidities, age, gender and BMI the groups were comparable.

Results

It was 3.5 times more likely to suffer from a medical complication if a two stage septic exchange was performed (OR 3.465, (95% CI: 2.573–4.358) [p<0.01]). In medical complications the two-stage group showed significantly more events (two-stage: 9 of 44=20.5%; one-stage: 30 of 385=7.8% [p=0.013]). The one-stage group showed more (not significant) nerve palsies after hip septic exchange. There was no difference in mortality between the groups (two-stage: 1/44=2.3%; one-stage: 3/385=0.8% [p=0.882]), the overall mortality was 0.93%. The duration of hospital stay was 23.9±19 days for the one-stage and 42.2±17.7 days for the two-stage group (p<0.001).

Conclusion

We found that it is more likely to develop a medical complication after two-stage septic revision arthroplasty. There was no difference in overall surgical complications between the two surgical approaches. We did not find a significant difference in short term mortality between the two techniques, although the mortality rate was slightly higher in the two-stage group.

Level of evidence

III, retrospective case control study.

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Keywords : Periprosthetic Joint Infection, One-Stage Septic Exchange, Two-Stage Septic Exchange, Complication Management, Total Joint Arthroplasty, Antibiotics